Introduction
COVID-19 pandemic outbreak in Italy started in February 2020 in Codogno (LO) and rapidly spread to most of the country. National and local regulators soon implemented emergency measures, including a generalized lockdown and reorganization of health institutions in response to the pandemic. BE-PACIFIC (Italian oBsErvational study on Patient mAnagement strategies in real-world Clinical practice For patIents with loCally advanced (stage III) NSCLC) is a multicenter observational retro-prospective cohort study designed to describe the management of patients with stage III NSCLC in the Italian real-life setting. Study includes patients with confirmed diagnosis of Stage III NSCLC at enrolment or within the prior 6 months. A total of 296 eligible patients were analysed between July 2020 and July 2021 in 40 participating Italian sites.
Methods
A subject-level analysis was performed on 296 eligible patients’ diagnostic procedures, treatment strategy and tumor resection. A site-level analysis was performed on 40 participating sites, in order to explore the COVID-19 pandemic impact on NSCLC diagnosis, treatment practice, including multidisciplinary team (MDT) management. Site-level data were collected through survey to physicians involved in the MDT to describe different scenarios encountered during the pandemic: most acute lockdown phase and time of loosening of COVID-19 health restrictions in Italy (between 1st and 30th sept 2021).
Results
A total of 222 patients were diagnosed and included before the first COVID-19 lockdown imposed on 10 march 2020, 74 patients completed the diagnostic process during the pandemic outbreak. During the pandemic, 26 sites (65%) declared impact on diagnosis and patient management: 55% declared changes in follow-up contacts modalities, 45% delays in radiological evaluations, 40% reported decreased number of diagnostic evaluations performed, 33% reported a decreased number of NSCLC diagnosis. MDT survey was completed by 39 sites. During the most acute phase of the pandemic, 5 sites (12.8%) reported absence or temporary absence of MDT meetings, 22 sites (56.4%) reported reduced MDT activity with respect to pre-COVID-19 outbreak, 12 sites (30.8%) reported regular MTD activity. Changes in MDT modalities and schedule persisted in 7 sites (18%) after the most acute phase of the pandemic (September 2021). Patients’ diagnostic process suffered reduced healthcare professionals presence: -28% of pathologist involvement, -23% of molecular biologist, -14% nuclear medicine physician, -13% of radiation oncologist, -11% of surgeon, -10% of pneumologist. Delayed surgery procedures were reported for 13 sites (32.5%); 5 sites (12.5%) reported delayed start of treatments. Sites reported changes in treatment type (13%) and schedule (18%), including minimization of hospital access, reduction of prescribed therapy dose and altered fractionation of radiotherapy.
Conclusions
MDT meeting activity changed in most participating sites during the acute phases of the pandemic, with potential impact on patient journey. Site-level data collected after the acute phase suggest that changes in MDT composition and schedule might not be reverted to pre-pandemic status in the short term. Pandemic seems to have impacted the diagnostic and monitoring processes more (65%) than the cancer treatment practice (45%) of participating sites.
Keywords
COVID-19, Stage III NSCLC, Multidisciplinary Team